As the medical director of the Johns Hopkins Biocontainment Unit, pulmonologist Brian Garibaldi was among the first to care for patients coming into the hospital with severe COVID-19. Almost immediately, he began meeting with other front-line clinicians to share observations that could help shape care protocols and clinical trials — at Johns Hopkins and beyond.
“We were only about two or three weeks into the pandemic,” recalls Garibaldi, “when Antony Rosen, vice dean for research for the school of medicine and the Cosner Family CIM Scholar, asked me a simple question: ‘What percentage of our patients have had a lab value of this particular amount?’ And I replied, ‘Gee, Antony, I can tell you anecdotally, but I can’t recall all of them.’”
“’We don’t have a data repository?’ Antony asked. ‘We have to create one right now!’”
And so they did. In the course of a weekend, the scientists conceived and submitted a plan for what has become the JH-CROWN registry, a collection of data and information about patients having suspected or confirmed cases of COVID-19 infection. While the main source is Johns Hopkins’ electronic medical record system, Epic, the registry also includes data from other sources, such as biospecimen repositories and physiologic device monitoring systems.
The registry, which utilizes the Johns Hopkins Precision Medicine Analytics Platform, offers a treasure trove of data that scientists across Johns Hopkins are tapping into for their COVID-19 research.
“The JH-CROWN registry currently includes data from 3,500 inpatients who tested positive for COVID-19 as well as data from tens of thousands of others who have been tested for COVID-19 at one of our Johns Hopkins locations,” says Garibaldi, the Douglas Carroll, MD, CIM Scholar. “Already, there are 25 approved research projects in the works, and many more will be coming online soon.”
“There are some truly exciting things happening with this data set,and it is really informing how we provide clinical care.” — Brian Garibaldi
Some investigations are descriptive, offering insights into the disease trajectory of a particular cohort of patients: “For instance, we are seeing ‘X’ number of Latinx patients with COVID-19, and this is how that rate is changing over time,” Garibaldi says. Other areas of inquiry are more complex — “such as scientists who are conducting comparative analyses of various treatments.”
In a paper published in late September in Annals of Internal Medicine, Garibaldi and biostatistician Jacob Fiksel provided insights into the disease trajectory of hospitalized patients with COVID-19 and the risk factors associated with severe outcomes. “Progression to severe disease or death can be rapid,” notes Garibaldi, “so the hope is that these insights can help clinicians intervene effectively during the narrow window after a patient is admitted.”
A number of other scholarly papers are currently under review, and Garibaldi expects them to be published soon. “There are some truly exciting things happening with this data set,” he says, “and it is really informing how we provide clinical care.”
Data from the JH-CROWN registry is also being shared with the National COVID Cohort Collaborative, a resource that is collecting data from electronic health records of different institutions across the country and harmonizing it into a “data enclave” for use by investigators all over the nation.
“By tapping into all of these data resources,” says Garibaldi, “we are really hoping to make discoveries that will change the way we think about COVID-19 and the way we manage it.”
Don Willett November 13th, 2020
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When the COVID-19 pandemic descended like a sledgehammer last winter, our nation’s senior population was impacted perhaps most severely. Virtually overnight, vulnerable older people — many coping with chronic illnesses, such as diabetes, heart disease and cancer — were confined to their homes and forced to shift to telehealth platforms for their health care.
For many older people, it wasn’t an easy transition to make. “Though a number of older adults are able to connect to video visits, accessing technology has been a big barrier for many, and some older adults do have technology, like smartphones or tablets, but may not know how to use them,” says Center for Innovative Medicine (CIM) Scholar Jessica Colburn, a specialist in geriatric medicine at Johns Hopkins Bayview Medical Center.
Before the pandemic hit, Colburn had been leading a series of community-based health initiatives for seniors living in communities across Maryland. Thanks in part to funding from an anonymous donor to the CIM, she and her team were able to mobilize to provide connection and health access to these seniors at the height of the COVID-19 crisis — and beyond.
“Because that funding was available immediately, we were able to respond quickly to the high needs that arose,” she says.
In one initiative, health educators Tracy Knox and Carolyn Moore reached out by phone to seniors who had previously completed a six-week course in chronic disease self-management. How can we best support you, they asked? One woman urgently needed an automated blood pressure reader because hers had broken, and it wasn’t safe for her to go out to the store. Other seniors asked for a supply of masks. The two health educators were only too happy to help.
“Because that funding was available immediately, we were able to respond quickly to the high needs that arose.” — Jessica Colburn
In addition to meeting those needs, Knox and Moore helped staff a caregiver service corps for the state, a telephone hotline for caregivers in immediate need. “Older adults and their caregivers had so many questions and so many worries. They were really struggling,” says Colburn. Patients and caregivers who called the hotline could speak with someone to guide them. “And we were able to connect them with resources for urgent needs, such as food, medications, backup respite care and equipment, such as hospital beds,” says Colburn.
Now, more than eight months into the COVID-19 crisis, many vulnerable seniors continue to remain at home — but their health needs must be met. In a partnership with Catholic Charities, Colburn and her colleagues have embarked on a pilot program with a 94-unit senior living facility in Baltimore County. The clinicians are providing residents with electronic tablets and coaching them on how to use them so that the seniors can comfortably connect with their health care providers via video visits. The Johns Hopkins team is using a similar strategy at a food distribution site on the Eastern Shore.
“The idea is that when seniors come to pick up food, they can do a video visit with their health care provider at the same time,” says Colburn.
For so many seniors living in the age of COVID-19, who are cut off from regular visits with friends and family and from the activities they love doing the most, social isolation has become a worrisome threat to health, notes Colburn. So she is also collaborating on a project with Johns Hopkins to assess the impact of hearing loss and social needs of older people living in senior housing. For that project, Colburn is working with Johns Hopkins ear, nose and throat specialist Carrie Nieman, who has expertise in hearing impairment, and geriatrician Thomas Cudjoe, who was recently appointed the Caryl & George Bernstein CIM Human Aging Project Scholar.
“Our goal is to work with primary care teams to come up with ways to help seniors make more effective social connections during this time of COVID-19,” she says.
“As we continue to live with the restrictions imposed by COVID-19, health outreach to older people and their caregivers in our community is more important than ever,” says Colburn. “We are grateful for the federal funding that has supported our work, but the additional money we have received from the Center for Innovative Medicine has allowed us to grow and expand in ways we could not have otherwise.”
Don Willett November 13th, 2020
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As COVID-19 has taken its grim toll, schoolchildren across the state and around the world have been plagued with questions and worries. “What we were hearing from our community partners is that teachers are really struggling to respond. All the kids want to talk about is COVID-19,” says Panagis Galiatsatos, the Aliki Perroti CIM Scholar and co-director of Medicine for the Greater Good, an important initiative of the Center for Innovative Medicine.
“Our partners asked: Can you please help?’”
Galiatsatos didn’t hesitate. “It seemed obvious that Johns Hopkins should be the source schools turn to for reliable information about COVID-19,” he says.
So, building on school connections that Medicine for the Greater Good had already established through the Lung Health Ambassadors initiative (see Breakthrough, Summer 2020), Galiatsatos worked with others across Johns Hopkins to create a COVID-19 curriculum for schoolchildren.
“What we’re hearing from teachers and superintendents is: You guys talk about science at a level we can understand. You’re providing power at a time when we all feel powerless, and hope when we feel hopeless.” — Panagis Galiatsatos
What started as a curriculum used in a handful of Baltimore City schools over the summer has now grown into a teaching series being used in 26 states (from New York to Hawaii) and in six countries, including Cypress, Guatemala, Ghana, Panama, Sudan and Tanzania. More than 90 volunteer instructors — including Johns Hopkins undergraduates; students from the schools of medicine, public health and nursing; and medical residents — have been trained to teach the classes.
Galiatsatos says the vision to create a COVID-19 school curriculum and take it beyond Baltimore schools came from Alicia Wilson, vice president for economic development at the Johns Hopkins University and Health System. “She saw the potential to bring together a cohort of the best of Johns Hopkins, experts from the schools of medicine, public health, nursing and education, to develop a curriculum that would really engage kids,” he says.
The resulting teaching series — which is offered remotely — is tailored for both elementary school children and middle and high schoolers, with 12 modules that last for 30 minutes each. Instructors spend the first part of each class leading a lesson on topics such as the physics behind face masks, mathematical models of the pandemic, and the chemistry of handwashing and hand sanitizer. Then they move to a hands-on activity and a chance for questions and answers.
“This is Medicine for the Greater Good at its very best! The schools are so appreciative, it just melts my heart,” says Galiatsatos, who has also led town hall discussions on the science of COVID-19 for some school systems. “What we’re hearing from teachers and superintendents is: You guys talk about science at a level we can understand. You’re providing power at a time when we all feel powerless and hope when we feel hopeless.”
Sara Wallam, a second-year medical student at Johns Hopkins, has completed her training and can’t wait to start teaching her first classes. “Like many other people, I’ve been worried about how some people are not taking this pandemic, and the necessary precautions, as seriously as health educators would like them to,” she says.
The COVID-19 curriculum for schools is a win-win, she says, empowering students to become health ambassadors within their communities: “This not only engages the individual students so that they will make healthier decisions for themselves, like wearing a mask, but they will take what they’ve learned and talk about it with their friends and family,” says Wallam.
Galiatsatos elaborates: “I’m a lung doctor who has been treating COVID-19 patients, and I think calling health care workers the front line is a misnomer,” he says. “I tell the students, who want to help protect others from the virus, that they are the front line of defense.”
Don Willett November 13th, 2020
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Chris Durso, a CIM Miller Coulson Scholar and one of the four architects of the Miller Coulson Academy of Clinical Excellence, has become the next director of the Department of Medicine at Johns Hopkins Bayview Medical Center. He succeeds Center for Innovative Medicine (CIM) Director David Hellmann, who led the department with distinction since 2000.
“Dr. Durso’s stellar leadership of the number one-ranked Division of Geriatric Medicine and Gerontology over the past decade speaks volumes, and his contributions as executive vice chair over the several months have only added to my confidence in his abilities,” noted Mark Anderson, director of the Department of Medicine in the Johns Hopkins University School of Medicine, in making the announcement. He added, “I am grateful to have someone so dedicated to JHBMC and the Department of Medicine take on this critically important leadership role — especially during this unprecedented time.”
In taking on leadership of the department, Durso steps down as director of the Division of Geriatric Medicine and Gerontology. Cynthia Boyd, the CIM Lavinia Currier Scholar, is now serving as interim director of the division.
Don Willett November 13th, 2020
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